RAUWOLFIAALKALOIDS (Systemic)
Some commonly used brand names are:
In the U.S.?
- Harmonyl 1
- Raudixin 2
- Rauval 2
- Rauverid 2
- Serpalan 3
- Wolfina 2
In Canada?
- Novoreserpine 3
- Reserfia 3
- Serpasil 3
Note: | For quick reference, the following rauwolfia alkaloids are numberedto match the corresponding brand names. |
Category
- Antihypertensive?Deserpidine; Rauwolfia Serpentina; Reserpine
- Vasospastic therapy adjunct?Deserpidine; RauwolfiaSerpentina; Reserpine
Description
Rauwolfiaalkaloids belong to the general class of medicines called antihypertensives.They are used to treat high blood pressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. Ifit continues for a long time, the heart and arteries may not function properly.This can damage the blood vessels of the brain, heart, and kidneys, resultingin a stroke, heart failure, or kidney failure. High blood pressure may alsoincrease the risk of heart attacks. These problems may be less likely to occurif blood pressure is controlled.
Rauwolfia alkaloids work by controlling nerve impulses along certain nervepathways. As a result, they act on the heart and blood vessels to lower bloodpressure.
Rauwolfia alkaloids may also be used to treat other conditions as determinedby your doctor.
These medicines are available only with your doctor's prescription, inthe following dosage forms:
Oral- Deserpidine
- Rauwolfia Serpentina
- Reserpine
- Tablets (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For rauwolfia alkaloids,the following should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to rauwolfia alkaloids. Also tell your health care professionalif you are allergic to any other substance, such as foods, preservatives,or dyes.
Pregnancy?Rauwolfia alkaloids have not been studied in pregnantwomen. However, too much use of rauwolfia alkaloids during pregnancy may causeunwanted effects (difficult breathing, low temperature, loss of appetite)in the baby. In rats, use of rauwolfia alkaloids during pregnancy causes birthdefects and in guinea pigs decreases newborn survival rates. Before takingthis medicine, make sure your doctor knows if you are pregnant or if you maybecome pregnant.
Breast-feeding?Rauwolfia alkaloids pass into breast milk and maycause unwanted effects (difficult breathing, low temperature, loss of appetite)in infants of mothers taking large doses of this medicine. Be sure you havediscussed this with your doctor before taking this medicine.
Children?Although there is no specific information comparinguse of rauwolfia alkaloids in children with use in other age groups, rauwolfiaalkaloids are not expected to cause different side effects or problems inchildren than they do in adults.
Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults. Although there is no specific informationcomparing use of rauwolfia alkaloids in the elderly with use in other agegroups, dizziness or drowsiness may be more likely to occur in the elderly,who are more sensitive to the effects of rauwolfia alkaloids.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingrauwolfia alkaloids, it is especially important that your health care professionalknow if you are taking any of the following:
- Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g.,Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline[e.g., Eldepryl], tranylcypromine [e.g., Parnate])?Taking a rauwolfiaalkaloid while you are taking or within 2 weeks of taking MAO inhibitors mayincrease the risk of central nervous system depression or may cause a severehigh blood pressure reaction
Other medical problems?The presence of other medicalproblems may affect the use of rauwolfia alkaloids. Make sure you tell yourdoctor if you have any other medical problems, especially:
- Allergies or other breathing problems such as asthma?Rauwolfiaalkaloids can cause breathing problems
- Gallstones or
- Stomach ulcer or
- Ulcerative colitis?Rauwolfia alkaloids increase activity ofthe stomach, which may make the condition worse
- Heart disease?Rauwolfia alkaloids can cause heart rhythm problemsor slow heartbeat
- Kidney disease?Some patients may not do well when blood pressureis lowered by rauwolfia alkaloids
- Mental depression (or history of)?Rauwolfia alkaloids causemental depression
- Parkinson's disease?Rauwolfia alkaloids can cause parkinsonism-likeeffects
Proper Use of This Medicine
For patientstaking this medicine for high blood pressure:
- In addition to the use of the medicine your doctor has prescribed,treatment for your high blood pressure may include weight control and carein the types of foods you eat, especially foods high in sodium. Your doctorwill tell you which of these are most important for you. You should checkwith your doctor before changing your diet.
- Many patients who have high blood pressure will not notice any signsof the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and thatyou keep your appointments with your doctor even if you feel well.
- Remember that this medicine will not cure your high blood pressurebut it does help control it. Therefore, you must continue to take it as directedif you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problemssuch as heart failure, blood vessel disease, stroke, or kidney disease.
To help you remember to take your medicine, try to get into the habit oftaking it at the same time each day.
This medicine is sometimes given together with certain other medicines.If you are using a combination of drugs, make sure that you take each medicineat the proper time and do not mix them. Ask your health care professionalto help you plan a way to remember to take your medicines at the right times.
If this medicine upsets your stomach, it may be taken with meals or milk.If stomach upset (nausea, vomiting, stomach cramps or pain) continues or getsworse, check with your doctor.
Dosing?The dose of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine.
For deserpidine- For oral dosage form (tablets):
- For high blood pressure:
- Adults?250 to 500 micrograms (mcg) a day. This may be takenas a single dose or divided into two doses.
- Children?Dose must be determined by your doctor.
For rauwolfia serpentina- For oral dosage form (tablets):
- For high blood pressure:
- Adults?50 to 200 milligrams (mg) a day. This may be taken asa single dose or divided into two doses.
- Children?Dose must be determined by your doctor.
For reserpine- For oral dosage form (tablets):
- For high blood pressure:
- Adults?100 to 250 micrograms (mcg) a day.
- Children?Dose is based on body weight and must be determinedby your doctor. The usual dose is 5 to 20 mcg per kilogram (kg) (2.27 to 9.1mcg per pound) of body weight a day. This may be taken as a single dose ordivided into two doses.
Missed dose?If you miss a dose of this medicine, do not takethe missed dose at all and do not double the next one. Instead, go back toyour regular dosing schedule.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It isimportant that your doctor check your progress at regular visits to make surethat this medicine is working properly.
For patients taking this medicine for high blood pressure:
- Do not take other medicines unless they havebeen discussed with your doctor. This especially includes over-the-counter(nonprescription) medicines for appetite control, asthma, colds, cough, hayfever, or sinus problems, since they may tend to increase your blood pressure.
Before having any kind of surgery (including dental surgery) or emergencytreatment, tell the medical doctor or dentist in chargethat you are taking this medicine.
In some patients, this medicine may cause mental depression. Tell your doctor right away:
- if you or anyone else notices unusual changes in your mood.
- if you start having early-morning sleeplessness or unusually vividdreams or nightmares.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;prescription pain medicine or narcotics; barbiturates; medicine for seizures;muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above whileyou are using this medicine.
This medicine may cause some people to become drowsy or less alert thanthey are normally. This is more likely to happen when you begin to take itor when you increase the amount of medicine you are taking. Make sure you know how you react to this medicine before you drive, use machines,or do anything else that could be dangerous if you are not alert.
This medicine may cause dryness of the mouth. For temporary relief, usesugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute.However, if dry mouth continues for more than 2 weeks, check with your medicaldoctor or dentist. Continuing dryness of the mouth may increase the chanceof dental disease, including tooth decay, gum disease, and fungus infections.
This medicine often causes stuffiness in the nose. However, do not usenasal decongestant medicines without first checking with your health careprofessional.
Side Effects of This Medicine
Suggestions that rauwolfia alkaloids may increase the risk of breast canceroccurring later have not been proven. However, rats and mice given 100 to300 times the human dose had an increased number of tumors.
Along with its needed effects, a medicinemay cause some unwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention.
Check with your doctor assoon as possible if any of the following side effects occur:
Signs and symptoms of overdose
Other side effects may occurthat usually do not need medical attention. These side effects may go awayduring treatment as your body adjusts to the medicine. However, check withyour doctor if any of the following side effects continue or are bothersome:
After you stop using thismedicine, it may still produce some side effects that need attention. Duringthis period of time check with your doctor immediately if you notice any of the following side effects:
Drowsiness or faintness; impotence ordecreased sexual interest; irregular or slow heartbeat; lack of energy or weakness; mental depression or inability to concentrate; nervousnessor anxiety; vivid dreams or nightmares or early-morningsleeplessness
Other side effects not listedabove may also occur in some patients. If you notice any other effects, checkwith your doctor.
Additional Information
Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although this use is not included in product labeling,reserpine is used in certain patients with the following medical condition:
Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for this use.
Revised: 08/19/1998
